A tour of the state forensic medical center illuminated the opioid epidemic
With some apprehension, I agreed to join colleagues from the Maryland General Assembly on a tour of the Maryland Office of the Chief Medical Examiner to learn about forensic investigations, evidence collection and cause and manner of death, issues relevant to topics debated in the House Judiciary Committee. They also are relevant to the state’s opioid epidemic. Key to our tour was the autopsy room, where about 5,000 autopsies are conducted each year. After covering our street clothes, we entered one of the two refrigerated autopsy rooms. On that morning, the room had fewer than a dozen unclothed corpses, each on a separate stainless-steel operating table, awaiting dissection.
I had been cautioned that I would see dead people but was assured that the handling of the bodies would be professional, clinical and deferential. Still, proximity to dead bodies was unsettling to me, so instead of averting my eyes and covering my nose to avoid the unfamiliar smell, I moved to the observation deck to view the exams.
Deaths from overdoses are not the only casualties of the drug epidemic. The indelible image of a young male body with multiple stab wounds reminded me that our state’s drug-addiction crisis has deadly and wide-ranging effects.
The forensic medical center is a high-tech facility open 24 hours a day, 365 days a year and staffed with more than 80 full-time employees and 120 part-time staff, including investigators and pathologists who perform forensic investigations, the primary tool to determine cause and manner of death. This state-of-theart facility is reminiscent of a university medical facility, conducive to scientific inquiry. OCME staff are specifically trained to recognize patterns of injury, collect evidence and investigate circumstances surrounding deaths. The OCME is the only place that investigates referred cases (about one-third of all deaths) brought from anywhere in Maryland.
The OCME holds training programs for forensic investigators and law enforcement. The facility has a realistic house in which trainers stage crime scenes for students to hone their skills. At a death scene, after first-responders arrive, forensic investigators are called to record and report observations before the body is transferred to the OCME. Our visit to an exhibit room of dioramas that re-create death scenes illuminated the difficulty in determining cause of death. By Maryland law, the OCME determines the cause of death with a reasonable degree of certainty for deaths from injury, homicide, suicide or unusual or suspicious circumstances in which a person is not under a physician’s care.
The OCME identifies mortality trends. A growing mortality trend in Maryland is opioid overdose. But overdose isn’t the only cause of death associated with addiction. According to the National Institute on Drug Abuse, drug abuse leads to health and public safety risks including addiction-related crimes, drugged driving, infectious disease, low-birth-weight babies and infant deaths.
Last year, Maryland had a 66 percent surge in drugand alcohol-related intoxication deaths. Many of these deaths were related to synthetic and prescription opioid-related overdoses, and they happen across race, age and economic levels. Understandably, Gov. Larry Hogan (R) declared a state of emergency.
Alcohol- and drug-related addiction can be treated as a public-health or a criminal-justice issue. The latter tactic, the war on drugs, has been tried in a failed, 40-year campaign intended to end the import, manufacture, sale and use of illegal drugs. It has done little to curtail drug addiction, but it has led to greater drug supply, mass incarceration and increased drug violence. Because of the war on drugs, many people view addiction as immoral or a character defect that requires punishment or incarceration.
Maryland is among the states allocating budget dollars to treating drug addiction as a chronic disease and creating policies to help people stop drug use, stay drug-free or delay the start of drug use.
Indeed, understanding the root cause deaths in our state can effect better public policy. I know Marylanders will be best served with an evolved drug policy, focused on addiction treatment, which will lead to fewer corpses at the shiny forensic medical center in Baltimore.